IN THE JUSTICE COURT OF RANKIN COUNTY, MISSISSIPPI STATE OF MISSISSIPPI VS. ____________________________ ORDER GRANTING EXPUNCTION OF RECORD THIS CAUSE came on for consideration of Defendant's Ore Tenus Petition Requesting Expunction of Record and the Court being satisfied that it has jurisdiction of the parties and the subject matter hereby FINDS, ORDERS and ADJUDGES that the Defendant was arrested for criminal charges and was released and the charges were dropped or there was no disposition. IT IS ORDERED that the following record of arrest shall be expunged from all public records: (a) (b) (c) (d) (e) Name the subject used at the Time of Arrest: Date of Birth: Social Security Number: Date of Arrest: on or about Charges at arrest: ; (f) Charges to be expunged: ; (g) (h) (i) (j) Name of Arresting Agency: Race: Sex: Statutory Authority: Miss. Code Ann. § 99-19-71. ; ; ; ; ; ; ; BOOK _______ PAGE _______ DEFENDANT
IT IS, FURTHER, ORDERED that a certified copy of this order shall be forwarded by the Justice Court Clerk to Mississippi Department of Public Safety, Criminal Information Center, Special Processing Unit (Expunctions), Post Office Box 958, Jackson, MS 39205. SO ORDERED, this the _____ day of _______________, 20_____.
__________________________________ Justice Court Judge